Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure-analysis of a population-based sample

Background Clinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from: center dot Kidney Disease Improving Global Outcomes (KDIGO,2012) center dot National Institute for Health and Care Excellence (NICE,2014) center dot German Society of Nephrology/German Society of Internal Medicine (DGfN/DGIM,2015) center dot German College of General Practitioners and Family Physicians (DEGAM,2019) center dot Kidney failure risk equation (NICE,2021) Methods Data of the population-based cohort Study of Health in Pomerania were matched with claims data. Proportion of subjects meeting referral criteria and corresponding health care expenditures were calculated and projected to the population of Mecklenburg-Vorpommern. Results Data from 1927 subjects were analysed. Overall proportion of subjects meeting referral criteria ranged from 4.9% (DEGAM) to 8.3% (DGfN/DGIM). The majority of patients eligible for referral were >= 60 years. In subjects older than 60 years, differences were even more pronounced, and rates ranged from 9.7% (DEGAM) to 16.5% (DGfN/DGIM). Estimated population level costs varied between euro1,432,440 (DEGAM) and euro2,386,186 (DGfN/DGIM). From 190 patients with eGFR < 60 ml/min, 15 had a risk of end stage renal disease > 5% within the next 5 years. Conclusions Applying different referral criteria results in different referral rates and costs. Referral rates exceed actually observed consultation rates. Criteria need to be evaluated in terms of available workforce, resources and regarding over- and underutilization of nephrology services.